Healthcare Provider Details

I. General information

NPI: 1912100942
Provider Name (Legal Business Name): JASON THOMAS OTTO PH.D., BCBA-D
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/07/2007
Last Update Date: 09/28/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3203 BRICK CHURCH PIKE SCARAB BEHAVIORAL HEALTH SERVICES, LLC
NASHVILLE TN
37207
US

IV. Provider business mailing address

3203 BRICK CHURCH PIKE SCARAB BEHAVIORAL HEALTH SERVICES, LLC
NASHVILLE TN
37207
US

V. Phone/Fax

Practice location:
  • Phone: 615-262-7822
  • Fax:
Mailing address:
  • Phone: 615-262-7822
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: